New Focus on Sleep Med Alternatives
Researchers are working to find sleep medications that avoid unwanted side effects, such as cognitive impairment, unusual nighttime behaviors, and risk of dependency, that are associated with many of the drugs currently in use. Their work has resulted in two new treatment options that individuals troubled by side effects linked to standard sleep medications may want to explore with their medical care providers.
One promising new development is the drug suvorexant (Belsomra®), which was ap-proved by the FDA on Aug. 13, 2014. The oral medication is taken a half-hour before bedtime in preparation for at least seven hours of sleep. It works by blocking brain chemicals called orexins that promote wakeful-ness, accelerating a decline in orexins that naturally occurs at night. Unlike drugs in current use, suvorexant does not appear to cloud cognition, and is not considered to be addictive.
“This is the first medication of its type approved by the FDA for use in the United States, although it has been very successful in other countries,” says Kenneth Sassower, MD, a neurologist at Massachu-setts General Hospital (MGH) and an expert in sleep disorders. “There is lots of excitement over its unique mechanism of action, and early studies have been positive.”
WHAT YOU CAN DO
Dr. Sassower recommends seeing a doctor about chronic insomnia. A consultation might include:
- A thorough physical exam, which might reveal physical problems that may be leading to sleep difficulties, such as iron deficiency anemia, which can trigger restless legs syndrome.
- A review of your medications to ensure that they are not related to your insomnia. For example, certain asthma drugs or over-the-counter cough syrups with pseudoephedrine can lead to wakeful-ness.
- A review of your medication schedule. Timing of medications can be important in pre-venting insomnia, too. For example, 10 percent of people who take statins at night may develop insomnia. Switching to taking the drug in the morning often improves sleep. Diuretic drugs, which can lead to frequent bathroom breaks at night, might be less troublesome if taken in the morning.
Another potentially effective new sleep medication is based on the hormone melatonin. It may be especially helpful for older individuals, who often experience lower levels of deep, slow-wave restorative sleep. Melatonin helps regulate the sleep/wake cycle, and is also a powerful antioxidant. Over-the-counter formulations of melatonin, although potentially beneficial, may not be sufficient for older adults, many of whom may be deficient in melatonin.
“One of the most promising agents for use in older adults is the prescription medication Ramelteon®, which binds to receptors for melatonin, promoting sleep,” says Dr. Sassower. “The medication can be six times as effective as over-the-counter melatonin in its ability to bring on sleep and appears to avoid many of the unwanted side effects of other sleep medications, such as depend-ence, slowed breathing, or interference with slow-wave sleep.”
Sleep problems widespread
An estimated one-third of American adults experience insomnia (difficulty falling or staying asleep, or frequent awakenings during the night). Sleep disturbance leads to next-day symptoms, such as fatigue, daytime drowsiness, irritability, and diminished alertness. Side effects linked to sleep medications are also widespread (See The Dangers of Sleep Med Side Effects). Recently, new research has raised concerns that insomnia may be associated with permanent negative structural changes in the brain.
A study published Sept. 9, 2014 in the journal Neurology tied chronic poor sleep quality to atrophy of the frontal cortex (responsible for higher brain functions such as thinking and initiating actions), along with other brain areas. Other research, published Mar. 18, 2014 in the Journal of Neuroscience, linked chronic sleep loss with irreversible physical damage to and loss of cells in a brain region called the locus coeruleus, which affects the sleep/wake cycle, memory, and cognitive control, among other functions.
“Until recently, it was not understood that sleep loss might cause lasting brain structural is-sues,” says Dr. Sassower. “These findings lend new importance to the search for safe and effective insomnia treatments.”
Alternatives to drugs
Taking a medication is certainly not the only way to ensure better sleep, Dr. Sassower says. There are a number of steps people with sleep problems can take to help set the stage for a better night’s rest. Among the measures that might help promote healthy sleep are:
▶ Good sleep hygiene. Ensure a sleep environment that is dark, quiet, and cool. The bed should be comfortable, and used only for sleeping or sex. Other strategies include: relaxing with quiet activities an hour before bedtime; refraining from exercise, excessive alcohol consumption, or caffeine intake four hours before bedtime; and going to bed and waking up at regular times.
▶ Regular exercise. Frequent workouts of a half-hour or more at least five days a week are linked to better sleep.
▶ Stress reduction. As much as possible, avoid situations that cause you stress. Use relaxation exercises such as yoga, meditation, and visualization to help you unwind before sleep.
▶ Cognitive behavioral therapy. Research suggests that counseling designed to identify and change thinking and behavior that interferes with sleep can be very helpful for insomnia.
▶ Treatment for depression and/or anxiety. Both of these psychological disorders can interfere with sleep.
▶ Pain treatment. Consult your doctor to address painful conditions that might interfere with your sleep.
▶ Treatment for sleep disorders, such as sleep apnea and uncontrollable leg movements called restless legs syndrome, which can result in frequent nighttime awakenings.
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